Improving access to acute stroke therapies: a controlled trial of organised pre-hospital and emergency care.
OBJECTIVE
To assess the effectiveness of the PAST (Pre-hospital Acute Stroke Triage) protocol in reducing pre-hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic therapy.


METHODS
Prospective cohort study using historical controls.


METHODS
Hunter Region of New South Wales, September 2005 to March 2006 (pre-intervention) and September 2006 to March 2007 (post-intervention).


METHODS
Consecutive patients presenting with acute stroke to a regional, tertiary referral hospital.


METHODS
PAST protocol, comprising a pre-hospital stroke assessment tool for ambulance officers, an ambulance protocol for hospital bypass for potentially thrombolysis-eligible patients, and pre-hospital notification of the acute stroke team.


METHODS
Proportion of patients who received intravenous tissue plasminogen activator (tPA), process of care time points (symptom onset to ED arrival, ED arrival to tPA treatment, and ED transit time), and clinical outcomes of patients treated with tPA.


RESULTS
The proportion of ischaemic stroke patients treated with tPA increased from 4.7% (pre-intervention) to 21.4% (post-intervention) (P < 0.001). Time point outcomes also improved, with a reduction in median times from symptom onset to ED arrival from 150 to 90.5 min (P = 0.004) and from ED arrival to stroke unit admission from 361 to 232.5 minutes (P < 0.001). Of those treated with tPA, 43% had minimal or no disability at 3 months.


CONCLUSIONS
Organised pre-hospital and ED acute stroke care increases patient access to tPA treatment, which is proven to reduce stroke-related disability.
Quain
Debbie A
DA
Hunter Medical Research Institute, Newcastle, NSW, Australia.
Parsons
Mark W
MW
Loudfoot
Allan R
AR
Spratt
Neil J
NJ
Evans
Malcolm K
MK
Russell
Michelle L
ML
Royan
Angela T
AT
Moore
Andrea G
AG
Miteff
Ferdinand
F
Hullick
Carolyn J
CJ
Attia
John
J
McElduff
Patrick
P
Levi
Christopher R
CR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D020521:Stroke / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014218:Triage / Q000458:organization & administration*; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator